The Persistent Jugular Artery: A Primitive Carotid-Basilar Anastomosis Traversing the Jugular Foramen

Background: Primitive arteries are persistent fetal anastomoses between the carotid and vertebral-basilar circulation. They are the trigeminal, otic, hypoglossal, and proatlantal intersegmental arteries. They emerge at the 4- to 5-mm embryonic stage, persist for approximately 1 week, and regress roughly at the rate at which the posterior communicating and vertebral arteries develop. Although rare, they can persist at birth. Their incidence is inversely related to the fetal period in which they appear.

Objective: This article aims to present a case of a patient with a persistent carotid basilar anastomosis that entered the skull through the jugular foramen and to review the literature on persistent fetal anastomoses.

Case Report: We describe the case of a 39-year-old female patient with a unique unnamed carotid-basilar anastomosis. A primitive artery that originates from the right internal carotid artery, passes the jugular foramen into the posterior cranial fossa, and continues to reach and merge with the basilar artery ([Figs. 1] [2] [3] [4]).

Fig. 1 3D reconstruction neck CTA showing an extra cervical vascular structure originating from the left internal carotid. This extra vessel represents the persistent jugular artery.

Fig. 2 CTA MIP reconstruction shows the persistent jugular artery reaching the posterior fossa via the jugular foramen.

Fig. 3 3D CT angiogram shows a primitive vessel entering the jugular fossa. The right vertebral artery is aplastic.

Fig. 4 3D reconstruction CT angiogram shows a primitive vessel that enters the skull through the jugular fossa. The right vertebral artery is aplastic. No additional anomalies in the cranial vasculature are noted.

Discussion: A literature review of the most common persistent carotid basilar anastomosis was conducted. The definitions, prevalence, and associated findings are presented. An additional review of the literature yielded three cases with a primitive artery that originates from the internal carotid artery, where the entry into the skull was the jugular foramen that merges with the basilar artery. We believe this artery does not meet the definition of any other carotid basilar anastomosis previously described and would constitute a new variant.

Conclusion: To our knowledge, this is the first review of its kind. We summarized both the current case of a new variant of a persistent primitive artery carotid-basilar anastomosis that passes through the jugular foramen and the previous cases reported in the literature to provide a definition for this new carotid basilar anastomosis variant. There are potential clinical implications related to its unique course. Additional reports would help to confirm the described morphogenesis and better understand its clinical implications.

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Artikel online veröffentlicht:
07. Februar 2025